Anoscope

ABSTRACT

An insertion device for use during surgical procedure to enlarge an opening in a patient&#39;s tissue to facilitate access to an internal treatment site with a surgical instrument. The insertion device includes an anoscope including a flange, and an elongate body having proximal and distal ends extending distally from the flange along a longitudinal axis. The anoscope may include a configuration that is asymmetrical about a plane extending along the longitudinal axis that bisects the flange.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.12/880,215 filed Sep. 13, 2010, which claims benefit of and priority toU.S. Provisional Application No. 61/249,652 filed Oct. 8, 2009, and thedisclosures of each of the above-identified applications are herebyincorporated by reference in their entirety.

BACKGROUND

1. Technical Field

The present disclosure relates to an insertion device that is adaptedfor positioning within an opening in tissue to facilitate access to aninternal treatment site with a surgical instrument. More particularly,the present disclosure relates to an anoscope kit for use with asurgical fastener applying apparatus.

2. Background of Related Art

A medical device used in the dilation and/or inspection of an internaltreatment site, e.g., a treatment site within a patient's anus, rectum,and/or colon, is often referred to as an anoscope. Anoscopes generallycomprise a hollow body that is configured and dimensioned for insertioninto an opening in the patient's tissue; either an opening that isnatural and pre-existing, e.g., the patient's anus, or an opening thatis formed by a clinician, e.g., an incision. The hollow body of theanoscope will generally include structure that is configured anddimensioned to dilate, and cover, the opening in the patient's tissue,as well as structure at the distal end thereof that is configured anddimensioned to accommodate the target tissue, e.g., hemorrhoidal tissue,such as a gap, notch, or slot.

After positioning the anoscope within the opening in the patient'stissue, the interior of the hollow body provides a passage through whichthe clinician can inspect the internal treatment site, and perform thesurgical procedure. For example, anoscopes are particularly useful inthe inspection and treatment of hemorrhoidal tissue, as well as tissuepositioned adjacent thereto, e.g., mucosal tissue, during hemorrhoidprocedures. During these procedures, the clinician will usually excisethe target tissue, and thereafter suture the treated area.

An anoscope including structure that is configured and dimensioned toincrease maneuverability and manipulation of the anoscope would bedesirable in the interests of allowing a clinician to more easily accessthe tissue that is the subject of the surgical procedure.

SUMMARY

In one aspect of the present disclosure, an insertion device isdisclosed for use during a surgical procedure to enlarge an opening in apatient's tissue to facilitate access to an internal treatment site witha surgical instrument. The disclosed insertion device includes ananoscope with a flange, and an elongate body having proximal and distalends that extends distally from the flange along a longitudinal axis. Inone embodiment, the anoscope includes a configuration that isasymmetrical about a plane extending along the longitudinal axis thatbisects the flange.

It is envisioned that the body of the anoscope may include a firstopening spaced longitudinally from a second opening, wherein the firstand second openings are aligned along the longitudinal axis.

The flange can include first and second circumferentially spaced endsdefining a gap therebetween that is configured and dimensioned toreceive tissue. In one embodiment, the anoscope includes at least onewing that extends outwardly from the flange relative to the longitudinalaxis. For example, the anoscope may include a single wing positionedeither adjacent one of the ends of the flange, or alternatively, betweenthe ends of the flange. In another embodiment, rather than just a singlewing, the anoscope may include a first wing and a second wing. In thisembodiment, it is envisioned that the first wing may extend outwardlyfrom the flange a first distance, whereas the second wing may extendoutwardly from the flange a second, greater distance. To enhancemaneuverability of the anoscope, the wing(s) may include a lip extendingalong a periphery creating a surface adjacent the lip to facilitatemaneuverability.

The presently disclosed insertion device may also include a dilator thatis configured and dimensioned for positioning within the body of theanoscope.

The insertion device may include a port defining a longitudinal openingtherethrough that is configured and dimensioned to receive the anoscope,wherein the port itself is configured and dimensioned for positioningwithin the opening in the tissue. It is envisioned that the port mayinclude a pair of wings extending outwardly therefrom along an axis thatis transverse in relation to the longitudinal axis such that thelongitudinal axis and the transverse axis define an acute angletherebetween. For example, the angle defined between the longitudinalaxis and the transverse axis may be approximately equal to 55°.

The present disclosure also provides in another aspect, an insertiondevice that includes an anoscope with a flange, and an elongate bodyhaving proximal and distal ends that extends distally from the flangealong a longitudinal axis. The anoscope includes a configuration that issymmetrical about a plane extending along the longitudinal axis thatbisects the flange. The anoscope includes a pair of wings that extendoutwardly from the flange relative to the longitudinal axis and curveoutwardly away from the distal end, wherein each of the wings includes alip extending in a proximal direction that is positioned along aperipheral edge thereof.

The distal end of the anoscope preferably includes a closed distal tipthat is configured and dimensioned to facilitate atraumatic advancementand/or rotation of the anoscope.

In yet another aspect of the present disclosure, an insertion device isdisclosed including a port defining a longitudinal opening therethroughthat is configured and dimensioned for positioning within the opening inthe tissue, an anoscope that is configured and dimensioned forpositioning within the longitudinal opening of the port, and a dilatorthat is configured and dimensioned for positioning within the body ofthe anoscope. The anoscope includes a flange, and an elongate bodyextending distally from the flange along a longitudinal axis. Theanoscope has a configuration that is asymmetrical about a planeextending along the longitudinal axis that bisects the flange.

It is envisioned that the anoscope may also include at least one wingextending outwardly from the flange relative to the longitudinal axis.

The port of the insertion device may include a pair of wings that extendoutwardly therefrom, wherein at least one of the wings includes anaperture that is configured and dimensioned to receive a flexible membersuch as a suture to facilitate attachment of the port to the patient'stissue. It is envisioned that the wings may extend outwardly along anaxis that is transverse in relation to the longitudinal axis such thatthe longitudinal axis and the transverse axis define an acute angletherebetween.

These and other features of the presently disclosed insertion devicewill become more readily apparent to those skilled in the art throughreference to the detailed description of various embodiments of thepresent disclosure that follows.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the present disclosure are described herein belowwith reference to the drawings, wherein:

FIG. 1 is a front, perspective view of an insertion device including anobturator, an anoscope, and a port in accordance with one embodiment ofthe present disclosure;

FIG. 2 is a side, perspective view of the insertion device of FIG. 1upon assembly;

FIG. 3 is a side, perspective view of a surgical fastener applyingapparatus for use with the presently disclosed insertion device during asurgical procedure;

FIG. 4 is a partial, longitudinal, cross-sectional view of a portion ofthe surgical fastener applying apparatus illustrating anvil and shellassembly components thereof;

FIG. 5 is a top, perspective view of an alternative embodiment of thepresently disclosed insertion device with the obturator removed;

FIG. 6 is a top, perspective view of another embodiment of the presentlydisclosed insertion device with the obturator removed;

FIG. 7 is a side, plan view of the port component of the insertiondevice of FIG. 1;

FIG. 8 is a longitudinal, cross-sectional view of the insertion deviceof FIG. 1 shown assembled and positioned within a patient;

FIG. 9 is a longitudinal, cross-sectional view of the insertion deviceof FIG. 1 positioned within a patient following removal of theobturator;

FIGS. 10-12 are proximal, end views of the insertion device positionedwithin a patient following removal of the obturator illustrating a pursestringing procedure in which a suture is attached to target tissue;

FIG. 13 is a longitudinal, cross-sectional view of the port component ofthe insertion device of FIG. 1 and the anvil assembly of the surgicalfastener applying apparatus of FIG. 3 positioned within a patientfollowing purse stringing and illustrating attachment of the suture tothe anvil assembly of the apparatus;

FIG. 14 is a partial, longitudinal, cross-sectional view of the portcomponent of the insertion device of FIG. 1 and the anvil assembly ofthe surgical fastener applying apparatus of FIG. 3 positioned within apatient following purse stringing and attachment of the anvil assemblyto an anvil retainer of the surgical apparatus;

FIG. 15 is a partial, longitudinal, cross-sectional view illustrating adistal end of the surgical fastener applying apparatus of FIG. 3positioned within the port component of the insertion device of FIG. 1following approximation of the anvil assembly and the shell assembly ofthe apparatus; and

FIG. 16 is a partial, longitudinal, cross-sectional view of the distalend of the surgical fastener applying apparatus of FIG. 3 followingremoval from the port component of the insertion device of FIG. 1 fromthe patient illustrating the removed target tissue within the shellassembly of the apparatus;

FIG. 17 is a top, perspective view of another embodiment of thepresently disclosed insertion device with the obturator removed; and

FIG. 18 is a top, perspective view of still another embodiment of thepresently disclosed insertion device with the obturator removed.

DETAILED DESCRIPTION

The presently disclosed insertion device will now be described in detailwith reference to the drawings, wherein like reference numeralsdesignate identical or corresponding elements. Throughout the followingdescription, the term “proximal” should be understood as referring tothe portion of the insertion device, or component thereof, that iscloser to the clinician during proper use, and the term “distal” shouldbe understood as referring to the portion of the insertion device, orcomponent thereof, that is further from the clinician during proper use.Additionally, the terms “hemorrhoidal tissue,” and the like, should beunderstood as referring to hemorrhoidal tissue, as well as tissuepositioned adjacent to hemorrhoidal tissue, including mucosal tissue.While the presently disclosed insertion device is particularly suitedfor surgical hemorrhoid procedures, the term “hemorrhoid procedure”should be understood to encompass surgical hemorrhoidectomies,hemorrhoidopexies, mucosectomies, procedures for the treatment of colonprolapse, and all such related procedures. The present disclosedinsertion device can also be used for surgical procedures other thanhemorrhoid procedures.

FIGS. 1 and 2 illustrate one embodiment of the presently disclosedinsertion device, which is identified by the reference character 1000.The insertion device 1000 is configured and dimensioned for use during asurgical procedure to enlarge an opening in a patient's tissue tofacilitate access to an internal treatment site with a surgicalinstrument. During the following discussion, the insertion device 1000will be discussed in the context of a surgical hemorrhoid procedure byway of example, wherein the target hemorrhoidal tissue “H” (see FIGS.13, 14) is removed from a patient's anal canal using a surgical fastenerapplying apparatus.

Referring to FIGS. 3 and 4, an exemplary embodiment of a suitablesurgical fastener applying apparatus, which is identified by thereference character 10, will be described, and a brief overview of thestructure and operation of the surgical fastener applying apparatus 10will be provided. Additional details regarding the surgical fastenerapplying apparatus 10 can be obtained through reference to U.S. patentapplication Ser. No. 12/550,443 filed on Aug. 31, 2009, the entirecontents of which are incorporated by reference herein. It should beunderstood however, that other surgical fastener applying apparatus canbe used with the insertion devices disclosed herein.

The surgical fastener applying apparatus 10 includes a handle assembly12, a central body portion 14 with an outer tube 16, and a distal headportion 18. The handle assembly 12 includes a stationary handle 20, afiring trigger 22, and a rotatable approximation knob 24.

The head portion 18 of the surgical fastener applying apparatus 10includes an anvil assembly 26 and a shell assembly 28. The anvilassembly is repositionable between an un-approximated position, whereinthe anvil assembly 26 is spaced a distance from the shell assembly 28(as in FIG. 3), and an approximated position, wherein the anvil assembly26 is closer to the shell assembly 28 to clamp tissue therebetween (seee.g. FIG. 15).

When the surgical fastener applying apparatus 10 is assembled, the anvilassembly 26 is positioned within an anvil retainer 30 that is movablerelative to the shell assembly 28 via an operative connection to theapproximation knob 24. Accordingly, during use of the surgical fastenerapplying apparatus 10, rotation of the approximation knob 24 effectuatesmovement of the anvil retainer 30, and consequently, the anvil assembly26, in relation to the shell assembly 28 to thereby transition the anvilassembly 26 between the un-approximated and approximated positions.

The surgical fastener applying apparatus 10 further includes a firingmechanism to facilitate the ejection of a plurality of surgicalfasteners 32 (FIG. 4) from the shell assembly 28 which are arranged in acircular array(s). The firing mechanism includes the aforementionedfiring trigger 20 (FIG. 3), which is operatively connected to a pusherback 34 (FIG. 4) component of the shell assembly 28. Upon actuation(pivoting) of the firing trigger 20, distal movement thereof causescorresponding distal movement of the pusher back 34 via a pusher link toeject the surgical fasteners 32 from the shell assembly 28. Uponejection from the shell assembly 28, the surgical fasteners 32 areforced into engagement with depressions (pockets) on an anvil plate 36(FIG. 4) component of the anvil assembly 26 to thereby form the surgicalfasteners 32. Contemporaneously with ejection of the surgical fasteners32, a circular knife member 38 is advanced distally through the pusherback 34 into engagement with the anvil assembly 26 to thereby severtissue positioned between the anvil assembly 26 and the shell assembly28.

Referring back to FIGS. 1 and 2, the components and structure of theinsertion device 1000 will be discussed in detail. The insertion device1000 includes an obturator 1100 with a dilating tip 1102, an anoscope1200, and a port 1300. In one embodiment of the insertion device 1000,it is envisioned that the anoscope 1200 and the port 1300 may be formed,either partially or wholly, from a clear material, e.g., polycarbonate,to facilitate the visualization of target tissue, as well as anyadjacent or surrounding tissue, during the surgical procedure. However,alternative materials of construction, e.g., materials allowing lesslight to pass through the anoscope 1200 and the port 1300, are withinthe scope of the present disclosure.

The anoscope 1200 includes a dished proximal flange 1202, and a sleeve1204 with respective proximal and distal ends 1206, 1208 that are spacedapart along a longitudinal axis “Y.” The flange 1202 extends outwardlyfrom the proximal end 1206 of the sleeve 1204 relative to thelongitudinal axis “Y,” and includes respective first and secondcircumferentially spaced ends 1210, 1212. The ends 1210, 1212 of theflange 1202 are connected by an arcuate portion 1214, and define a gap“G”. The arcuate portion 1214 may define an arc of approximately 180°.However, the arc defined by the arcuate portion 1214 may be eitherlarger or smaller in alternative embodiments of the present disclosure.

The anoscope 1200 further includes a single wing 1216 that extendsoutwardly from the flange 1202 relative to the longitudinal axis “Y” ina manner resulting in a configuration that is asymmetrical about a planeextending along the longitudinal axis “Y” that bisects the flange 1202.The wing 1216 is configured and dimensioned for manual engagement by theclinician to facilitate manipulation of the anoscope 1200 during thecourse of the surgical hemorrhoid procedure. In one embodiment of theanoscope 1200, the wing 1216 may be positioned adjacent one of the ends1210, 1212 of the flange 1202, e.g., the second end 1212, as shown inFIG. 1. Alternatively, however, the wing 1216 may be positioned at alocation between the ends 1210, 1212 of the flange 1202.

Referring to FIG. 5, an embodiment of the anoscope, generally designatedby reference numeral 1200′, is illustrated wherein the wing 1216′ ispositioned at a location equidistant from the ends 1210′, 1212′ of theflange 1202′ such that the wing 1216′ is positioned opposite the gap“G”' defined between the ends 1210′, 1212′. The arcuate portion maydefine an arc of approximately 180°, although smaller or greater arcsare also contemplated. In this embodiment, the configuration issymmetrical about a plane extending along the longitudinal axis “Y” thatbisects the flange 1202′, and the wing 1216′ provides the clinician witha way to ascertain the position of the gap “G” to facilitate accurateplacement of the anoscope relative to the target tissue H. The wing1216′ preferably angles upwardly similar to the wings of the embodimentof FIG. 17 and has a lip along a periphery to facilitatemaneuverability. The anoscope of FIG. 5 is otherwise the same as theanoscope of FIG. 1 and can be used with the port and dilator of FIG. 1.

Referring again to FIGS. 1 and 2, the wing 1216 includes a proximalsurface 1218 which may be substantially uniform in configuration, i.e.,a proximal surface 1218 that is free from any indentations, protrusions,or other such irregularities. Alternatively, the proximal surface 1218of the wing 1216 may include textured surfaces, or the like tofacilitate manual manipulation of the anoscope 1200 by the clinician.

The sleeve 1204 of the anoscope 1200 extends distally from the flange1202 and defines an internal dimension that allows for removablereception of the obturator 1100 therein. The sleeve 1204 includes aclosed distal tip 1220 having an atraumatic, e.g., conicalconfiguration. This configuration facilitates the dilation of tissue,such as the patient's anal canal, and thus, insertion and advancement ofthe anoscope 1200, as well as rotation of the anoscope 1200 oncepositioned internally.

In one embodiment of the anoscope 1200 a, which can be seen in FIG. 6,the sleeve 1204 a may include markings 1222 a to assist the clinician inthe placement of purse strings. The markings are placed along anexterior of the body, adjacent distal opening 1230 a . Preferably, themarkings extend around the entire body from edge 1241 a to edge 1242 aof distal opening 1230 a. Specifically, the markings 1222 a allow theclinician to easily ascertain the depth to which the anoscope 1200 a hasbeen inserted within the opening in the patient's tissue, e.g., thedepth within the patient's anal canal. By allowing the clinician toeasily determine the depth to which the anoscope 1200 a has beeninserted, the markings 1222 a facilitate the placement of purse stringsat a consistent distance from the opening in the patient's tissue.Although five markings 1220 are shown, a different number of markings isalso contemplated. In all other respects, anoscope 1200 a is the same asanoscope 1200 of FIG. 1 and can be utilized with the port and dilator ofFIG. 1.

Returning to FIGS. 1 and 2, the sleeve 1204 also includes an open region1224 that extends longitudinally therethrough along the axis “Y,” and abridge 1226 that spans the open region 1224 to thereby divide the openregion 1224 into respective proximal and distal openings 1228, 1230. Thebridge 1226 may extend across the open region 1224 to define an archaving any suitable dimensions. For example, as illustrated in FIG. 1,the arc defined by the bridge 1226 may extend less than 180°. However,an arc greater than 180° is also within the scope of the presentdisclosure.

The configuration of the bridge 1226 may be altered or varied inalterative embodiments of the anoscope 1200 to realize any suitableaxial length. In one particular embodiment, the bridge 1226 defines anaxial length of about 1.5 cm (approximately 0.59 inches), and ispositioned such that respective proximal and distal ends 1232, 1234 ofthe bridge 1226 are located about 3 cm (approximately 1.18 inches) andabout 4.5 cm (approximately 1.77 inches) from the proximal end 1206 ofthe sleeve 1204, i.e., from the point of contact between the flange 1202and the sleeve 1204. In this embodiment, during the course of ahemorrhoid procedure, upon insertion of the anoscope 1200 into thepatient's anal canal, the distal opening 1230 in the sleeve 1204 will bepositioned above (proximally) of the dentate line, which is located inthe human anal canal about 2 cm (approximately 0.78 inches) from theanus. With the distal opening 1230 positioned proximally of the dentateline, purse stringing, and subsequent tissue removal, will also occurproximally of the dentate line.

With reference now to FIGS. 1 and 7, the port 1300 of the insertiondevice 1000 will be discussed. The port 1300 defines an internaldimension that allows for removable reception of the anoscope 1200, andincludes a pair of wings 1302 that are configured and dimensioned formanual engagement by the clinician to facilitate handling andmanipulation of the port 1300 during the course of the surgicalprocedure. The wings 1302 extend outwardly from the port 1300 relativeto the longitudinal axis “Y.” Specifically, the wings 1302 each extendalong an axis “T” (FIG. 7) that is transverse in relation to thelongitudinal axis “Y” to subtend an angle a therewith. It is envisionedthat the angle a may lie substantially within the range of approximately45° to approximately 90°. For example, in the embodiment of the port1300 illustrated in FIGS. 1 and 7, the axis “T” along which the wings1302 extends defines an angle of approximately 55° with the longitudinalaxis “Y.” However, larger and smaller values for the angle .alpha. arealso contemplated.

As best seen in FIG. 1, the wings 1302 of the port 1300 include a pairof apertures 1304 that are configured and dimensioned to receive aflexible member (not shown), such as a suture, that can be secured tothe patient's tissue in order to facilitate fixation of the port 1300relative thereto. However, an embodiment of the port 1300 in which thewings 1302 have a different number of apertures or are devoid of theapertures is also contemplated.

The use and operation of the insertion device 1000 (FIGS. 1, 2) will bediscussed in connection with the surgical fastener applying apparatus 10(FIGS. 3, 4) in the context of a surgical hemorrhoid procedure, it beingunderstood that the other insertion devices (i.e. other anoscopes)disclosed herein would be used in a similar manner. Prior to insertion,the anvil assembly 26 is removed from the anvil retainer 30, and theinsertion device 1000 is assembled as illustrated in FIG. 2.Specifically, the anoscope 1200 is positioned coaxially within the port1300, and the obturator 1100 is positioned coaxially within the sleeve1204 of the anoscope 1200. The assembled insertion device 1000 is theninserted transanally into an opening in the patient's tissue such thatthe bridge 1226 is positioned above the dentate line (see FIG. 8).Thereafter, the obturator 1100 is removed, leaving the anoscope 1200positioned within port 1300, as seen in FIG. 9, such that the port 1300extends from the patient's anus. Either prior or subsequent to assemblyof the insertion device 1000, the port 1300 may be optionally fixed tothe patient's tissue by the aforementioned flexible member (not shown).

As seen in FIG. 9, following removal of the obturator 1100, the targettissue, e.g., internal hemorrhoidal tissue “H,” is received by thedistal opening 1230 in the sleeve 1204 such that the tissue “H” ispositioned within the sleeve 1204 of the anoscope 1200. The clinicianthen attaches a length of suture to the target tissue “H,” a procedurewhich is generally referred to as “purse stringing.” Thereafter, theanoscope 1200 can be rotated within the port 1300 to one or moresubsequent positions, exemplified in the transition between FIGS. 10,11, and 12, such that additional internal hemorrhoidal tissue “H,” ifany, can be received within the distal opening 1230, and purse stringed.

After purse stringing is completed, the anoscope 1200 is removed fromthe patient's anus. The anvil assembly 26 (FIG. 13) of the surgicalfastener applying apparatus 10 is then inserted through the port 1300into the patient's anal cavity, and the two ends of the suture “S” areattached to the anvil assembly 26. For instance, in the illustratedembodiment of the surgical fastener applying apparatus 10, the ends ofthe suture “S” are inserted into aperture 40B of the apertures 40A-40C(FIGS. 3, 4, 13) formed in a center rod 42 component of the anvilassembly 26. The apertures 40A-40C through which the ends of the suture“S” are inserted is dependent upon the amount of tissue the clinicianwishes to draw into the shell assembly 28 during approximation of theanvil assembly 26 and the shell assembly 28, the proximalmost aperture40A providing the greatest amount of tissue. The length of the suture“S” is such that the suture “S” extends from the port 1300 afterpositioning within the select aperture 40A-40C.

Following attachment of the suture “S” to the center rod 42, the anvilassembly 26 is re-connected to the surgical fastener applying apparatus10 by positioning the anvil assembly 26 within the anvil retainer 30, asshown in FIG. 14. Next, the approximation knob 24 (FIG. 3) of apparatus10 is rotated to move the anvil assembly 26 proximally towards the shellassembly 28 such that the target tissue “H” is drawn into, andpositioned within, the shell assembly 28, as shown in FIG. 15. Thesurgical fastener applying apparatus 10 is then fired to sever andfasten the target tissue “H.” After severing of the tissue “H,” thesurgical fastener applying apparatus 10 can be removed from the port1300 with the tissue “H” positioned within the shell assembly 28, asshown in FIG. 16.

With reference now to FIGS. 17 and 18, alternative embodiments of theanoscope component of the presently disclosed insertion device 1000(FIG. 1) will be discussed. Each embodiment of the anoscope discussedherein below is similar to the anoscope 1200 that was discussed abovewith respect to FIGS. 1 and 2, for example, and accordingly, will onlybe described with respect to any differences therefrom.

FIG. 17 illustrates an embodiment of the anoscope that is identified bythe reference character 1400 and is shown positioned within the port1300. In contrast to the aforedescribed anoscope 1200 (FIGS. 1, 2),which includes only a single wing 1216, the anoscope 1400 includes afirst wing 1416A and a second wing 1416B that each extend outwardly fromthe dished flange 1402. In the illustrated embodiment, the wings 1416A,1416B are positioned adjacent the ends 1410, 1412 of the flange 1402,respectively. More specifically, in the illustrated embodiment, the ends1410, 1412 of the flange 1402, and thus, the wings 1416A, 1416B, arediametrically opposed. In alternative embodiments of the anoscope 1400,however, it is envisioned that the wings 1416A, 1416B may be spaced fromthe ends 1410, 1412 of the flange 1402.

The structure of the first wing 1416A differs from that of the secondwing 1416B such that the configuration of the anoscope 1400 isasymmetrical about a plane extending along the longitudinal axis “Y”that bisects the flange 1402. In the specific embodiment of the anoscope1400 illustrated in FIG. 17, the first wing 1416A extends outwardly fromthe flange 1402 a first distance “X1,” whereas the second wing 1416Bextends outwardly from the flange 1402 a second, greater distance “X2.”The shorter distance “X1” defined by the first wing 1416A reduces thelikelihood that the first wing 1416A will interfere with manipulation ofthe anoscope 1400 during the surgical procedure via contact with thepatient's tissue.

To facilitate manual engagement with the wings 1416A, 1416B, the wings1416A, 1416B include a raised protrusion 1436. The protrusions 1436extend away from the wings 1416A, 1416B in a proximal direction todefine a height “H,” and corresponding adjacent area 1438 to therebyenhance maneuverability of the anoscope 1400.

In the illustrated embodiment, the protrusions 1436 are configured asribs, or flanges, 1440 that are positioned adjacent a peripheral edge“P” of the wings 1416A, 1416B. It should be understood, however, that inalternative embodiments of the anoscope 1400, the protrusion 1436 mayassume any configuration suitable for the intended purpose of increasingthe clinician's control over, and ability to manipulate, the anoscope1400, and that other configurations for the protrusion 1436 are notbeyond the scope of the present disclosure. It is also envisioned thatthe wings 1416A, 1416B may be devoid of the protrusions 1436 such thatthe wings 1416A, 1416B include a substantially uniform proximal surface1418, i.e., a surface that is free from any indentations, protrusions,or other such irregularities, as discussed above with respect to theanoscope 1200 (FIGS. 1, 2).

FIG. 18 illustrates another embodiment of the anoscope that isidentified by the reference character 1500 and is shown positionedwithin the port 1300. Like the anoscope 1400 described with respect toFIG. 17, the anoscope 1500 includes a first wing 1516A and a second wing1516B that each extend outwardly from the dished flange 1502. However,in contrast to the first and second wings 1416A, 14166 of the anoscope1400, the structure of the first wing 1516A is identical to that of thesecond wing 1516B such that the configuration of the anoscope 1500 issymmetrical about a plane extending along the longitudinal axis “Y” thatbisects the flange 1502. In the specific embodiment of the anoscope 1500illustrated in FIG. 18, the first wing 1516A and the second wing 1516Beach extend outwardly from the flange 1502 a distance “X3.” The wings1516A and 1516B curve proximally forming arcuate regions.

To facilitate manual engagement with the wings 1516A, 1516B, as with theaforedescribed anoscope 1400 (FIG. 17), it is envisioned that the wings1516A, 1516B may each include a raised protrusion 1536. The protrusions1536 extend away from the wings 1516A, 1516B in the proximal directionto define a height “H2” that is greater than the height “H” defined bythe protrusions 1436 included on the wings 1416A, 1416B of the anoscope1400 (FIG. 17). The increased height “H2” of the protrusions 1536increases both the depth of the surfaces 1538 defined thereby, as wellas the surface area available for contact with the clinician, e.g., withthe clinician's finger(s). Thus, the increased height “H2” of theprotrusions 1536 further increases the clinician's control over, andability to manipulate, the anoscope 1500.

Although illustrated as a rib, or flange, 1540 that extends along theperipheral edge “P” of the wings 1516A, 15166, it should be understoodthat the protrusions 1536 may assume alternative configurations inadditional embodiments of the anoscope 1500, and that the protrusions1536 (as well as protrusions 1436 of FIG. 17) may be spaced from theperipheral edge “P” of the wings without departing from the scope of thepresent disclosure.

Persons skilled in the art will understand that the devices and methodsspecifically described herein and illustrated in the accompanyingdrawings are non-limiting exemplary embodiments. It is envisioned thatthe elements and features illustrated or described in connection withone exemplary embodiment may be combined with the elements and featuresof another without departing from the scope of the present disclosure.As well, one skilled in the art will appreciate further features andadvantages of the invention based on the above-described embodiments.Accordingly, the invention is not to be limited by what has beenparticularly shown and described, except as indicated by the appendedclaims.

1-20. (canceled)
 21. A method of surgery, the method comprising:inserting an anoscope into an anus of a patient with a bridge of theanoscope positioned past a dentate line, the anoscope including a flangeand an elongate body having an outer wall, the flange including a wingand having first and second ends spaced apart from one another to definea gap, the wing being positioned about the flange such that the flangeis asymmetrical about a vertical plane bisecting the flange, the outerwall defining a proximal opening and a distal opening longitudinallyaligned with one another, the bridge separating the proximal opening andthe distal opening; purse-stringing hemorrhoidal tissue positionedwithin the outer wall of the anoscope, the hemorrhoidal tissue passingthrough the distal opening of the anoscope; and withdrawing the anoscopefrom the anus of the patient.
 22. The method according to claim 21,wherein purse-stringing the hemorrhoidal tissue includes rotating theanoscope.
 23. The method according to claim 21, wherein purse-stringingthe hemorrhoidal tissue includes attaching a suture to a first portionof the hemorrhoidal tissue positioned within the outer wall of theanoscope and rotating the anoscope to attach the suture to a secondportion of the hemorrhoidal tissue.
 24. The method according to claim21, further comprising inserting a surgical stapler into the anus of apatient after withdrawing the anoscope.
 25. The method according toclaim 21, further comprising assembling an insertion device beforeinserting the anoscope into the anus of a patient.
 26. The methodaccording to claim 25, wherein assembling the insertion device includespositioning the anoscope within a port.
 27. The method according toclaim 26, wherein inserting the anoscope into the anus of the patientincludes positioning the port in the anus.
 28. The method according toclaim 27, further comprising securing the port to the patient.
 29. Themethod according to claim 25, wherein assembling the insertion deviceincludes positioning an obturator within the outer wall of the anoscope.30. The method according to claim 29, wherein inserting the anoscopeinto the anus of the patient includes observing the position of thebridge within the anus of the patient with the obturator duringinsertion of the anoscope and withdrawing the obturator from theanoscope after the bridge is positioned past the dentate line.